Ultrasound Findings versus Hysteroscopic Guided Endometrial Histopathological Findings in Women with Postmenopausal Bleeding

Background: Postmenopausal bleeding (PMB) is a common clinical presentation with a broad differential diagnosis, including atrophic endometrium, endometrial hyperplasia, polyps, and carcinoma. Accurate diagnosis is crucial for appropriate management. This prospective study aimed to correlate transvaginal morphological ultrasound findings with histopathological findings from hysteroscopic-guided endometrial biopsies in women with PMB, to assess the diagnostic accuracy of ultrasound compared to the gold standard of histopathology.Methods: This prospective study was conducted at the Banha University Hospitals' obstetrics and gynecology outpatient clinics, including 59 women with PMB. Detailed patient histories, physical examinations, laboratory investigations, ultrasonography, and hysteroscopic-guided endometrial biopsies were performed. Results: The study group had a mean age of 57.77 years and a mean BMI of 30.17 kg/m2. Histopathology identified atrophic endometrium (37.3%), endometrial hyperplasia (54.2%), endometrial polyps (6.8%), and endometrial carcinoma (1.7%). The mean endometrial thickness measured by ultrasound was 14.42 ± 7.93 mm. Ultrasonography showed high PPV and NPV for endometrial hyperplasia (96.97% PPV, 100% NPV) but lower for endometrial carcinoma (33.33% PPV) and polyps (66.67% PPV). Hysteroscopy yielded higher agreement rates with histopathology than ultrasound, particularly for diagnosing atrophic endometrium, endometrial carcinoma, and polyps, with kappa values indicating substantial to almost perfect agreement.Conclusion: Hysteroscopic-guided biopsy, supported by transvaginal ultrasound, offers a reliable approach for diagnosing endometrial pathologies in women with PMB. While ultrasound is valuable for initial assessment, particularly for endometrial hyperplasia, its limitations in detecting carcinoma and polyps suggest that hysteroscopy should be considered when ultrasound findings are inconclusive or indicate potential malignancy.